Abstract
BackgroundDespite the scarce evidence for patients’ benefits of coercion and its well-documented negative effects, the use of compulsion is still very common around Europe, with important variations among different countries. These variations have been partially explained by the different legal frameworks, but also by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures. This study aimed to compare the socio-demographic and clinical profile as well as the referral and hospitalisation process of people voluntarily and involuntarily hospitalized in order to identify which factors could be associated with the use of coercion.MethodsAll psychiatric admissions occurred between the 1st January 2015 and the 31st December 2015 were included in this retrospective study (n = 5027). The whole sample was split into two subgroups accordingly to the hospitalisation legal status at admission (voluntary vs involuntary) and differences between the two groups were examined. In order to identify the factors associated with coercion, all the variables reaching a p < .01 level of significance when comparing the two groups were included as independent variables into a multivariate logistic regression model.ResultsGlobally, 62% of the admissions were voluntary and 38% were involuntary. Compared to the voluntary group, involuntary patients were significantly older, more frequently widowed and living in one specific district, and had a main diagnosis of schizophrenia (F20-F29) or organic mental disorders (F00-F09). People affected by organic mental disorders (F00-F09), with higher levels of psychotic symptoms, aggression and problems with medication adherence, were more likely to be involuntarily admitted. Moreover, living in District 1, being referred by a general practitioner, a general hospital or a psychiatric hospital and being involuntarily admitted during the previous 12 months, was associated with a higher risk of coercion.ConclusionsThis study identified several individual-related, as well as system-related factors associated with the use of coercion. These results allowed us to trace a clearer profile of high-risk patients and to provide several inputs that could help local authorities, professionals and researchers to develop better-targeted alternative interventions reducing the use of coercion.
Highlights
Despite the scarce evidence for patients’ benefits of coercion and its well-documented negative effects, the use of compulsion is still very common around Europe, with important variations among different countries
The rates of involuntary hospitalisations in Europe may range from 3 to 30% of total psychiatric admissions [8]. These variations have been partially explained by the different legal frameworks in place within each country [9], and by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures
Study design and setting In Switzerland, involuntary admissions are regulated by the Article 426 and 427 of the Swiss Civil Code (CC), which states that a person suffering from mental disorder, mental disability or serious neglect may be committed to an appropriate institution if the required treatment cannot be provided otherwise
Summary
Despite the scarce evidence for patients’ benefits of coercion and its well-documented negative effects, the use of compulsion is still very common around Europe, with important variations among different countries These variations have been partially explained by the different legal frameworks, and by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures. The rates of involuntary hospitalisations in Europe may range from 3 to 30% of total psychiatric admissions [8] These variations have been partially explained by the different legal frameworks in place within each country [9], and by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures. While some studies found that the annual reduction in provision of psychiatric beds was significantly associated with increased rates of involuntary admission [21], others highlighted that this association was rather weak and that future research should take the influence of other service system characteristics into account [22]
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